Request an Appointment

Send the office your preferences. Your appointment is not confirmed until the All Smiles team contacts you.

Appointment request

Tell us what works for you

Please complete this request form. An appointment is not confirmed until our office contacts you.

Fields marked “required” must be completed.

Appointment request details

Patient Name (required)

Phone Number (required)

Email (required)

Who is the appointment for? (required)

Adult Child

Is the patient a male or a female? (required)

Male Female

Do you have a weekday preference? (required)

Monday Tuesday Wednesday Thursday No preference

Do you have a preferred time of day? (required)

Morning Afternoon

Do you have insurance? (required)

Yes No

What is the name of your insurance company? (optional)

Please add any additional information or comments. (optional)

Your answers will be emailed to the office. An appointment is not confirmed until the office contacts you.

Visit us

All Smiles Dental
1316 Mill Street
Crawfordsville, IN 47933

Friendly, thoughtful dental care for Crawfordsville families.

Need help accessing any part of this website? Contact us or call 765-362-9245.